Prevalence and determinants of chronic pain and persistent opioid use after surgery: A review of systematic reviews

IF 1.3 Q4 CLINICAL NEUROLOGY British Journal of Pain Pub Date : 2023-10-17 DOI:10.1177/20494637231204549

Neetu Bansal, Sheanne Ang, Li-Chia Chen

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Abstract

Background Chronic post-surgical pain (CPSP) and persistent post-operative opioid use (PPOU) are inconsistently defined in published literature. This review comprehensively summarised their definitions, prevalence and determinants from existing systematic reviews or meta-analyses. Methods Systematic reviews or meta-analyses evaluating the prevalence of CPSP and PPOU in adults after surgeries were retrieved from an electronic database search applying structured search strategies in PubMed, MEDLINE, Embase, CINAHL Plus and Cochrane Database of Systematic Reviews from inception to 31 December 2022. Two reviewers selected systematic reviews, extracted data regarding the definition, prevalence and risk factors of CPSP and PPOU and assessed the quality using the AMSTAR 2 tool. Results The study identified 6936 records related to chronic pain and persistent opioid use in patients after surgery, of which 24 articles were identified for full-text review. Eighteen systematic reviews were included in this umbrella review, of which five systematic reviews assessed chronic pain in patients who had undergone a surgical procedure, and 13 reviews assessed persistent opioid use after surgery. Despite considerable variations in patient characteristics (from age ≥18 years), types of surgeries, follow-up duration and the definitions of measures, most reviews were of medium to good quality (fulfilled 9-11/16 AMSTAR 2 criteria). The prevalence of CPSP and PPOU, commonly synthesised at 3, 6 or 12 months after surgeries, varied from 5%–58% and 2%–65%, respectively, despite various terminologies, definitions and timing of measures and associated determinants. The prevalence of neuropathic pain in CPSP was obtainable for four surgeries, with 9%–74%. Conclusion To inform future practice and policy to optimise pain management and opioid safety, consensus on standardising measurements and further studies assessing risk factors associated with CPSP, PPOU and adverse outcomes are needed.

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手术后慢性疼痛和持续阿片类药物使用的患病率和决定因素:系统综述

背景:在已发表的文献中，慢性术后疼痛(CPSP)和持续性术后阿片类药物使用(PPOU)的定义不一致。本综述从现有的系统综述或荟萃分析中全面总结了它们的定义、患病率和决定因素。方法应用PubMed、MEDLINE、Embase、CINAHL Plus和Cochrane系统评价数据库从成立至2022年12月31日的结构化搜索策略，从电子数据库检索评估成人术后CPSP和PPOU患病率的系统评价或荟萃分析。两名审查员选择了系统评价，提取了关于CPSP和PPOU的定义、患病率和危险因素的数据，并使用AMSTAR 2工具评估了质量。结果本研究共发现6936例与术后患者慢性疼痛和持续性阿片类药物使用相关的记录，其中24篇被纳入全文综述。这项总括性综述包括18项系统综述，其中5项系统综述评估了接受手术的患者的慢性疼痛，13项综述评估了手术后持续使用阿片类药物。尽管患者特征(年龄≥18岁)、手术类型、随访时间和测量方法的定义存在相当大的差异，但大多数评价的质量为中等至良好(符合9-11/16 AMSTAR 2标准)。尽管有不同的术语、定义、测量时间和相关决定因素，CPSP和PPOU的患病率分别为5%-58%和2%-65%，通常在手术后3、6或12个月合成。CPSP患者神经性疼痛的发生率在4次手术中为9%-74%。结论为优化疼痛管理和阿片类药物安全性的未来实践和政策提供信息，需要就标准化测量达成共识，并进一步研究评估与CPSP、PPOU和不良后果相关的风险因素。

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来源期刊

British Journal of Pain CLINICAL NEUROLOGY-

CiteScore

3.20

自引率

11.10%

发文量

期刊介绍： British Journal of Pain is a peer-reviewed quarterly British journal with an international multidisciplinary Editorial Board. The journal publishes original research and reviews on all major aspects of pain and pain management. Reviews reflect the body of evidence of the topic and are suitable for a multidisciplinary readership. Where empirical evidence is lacking, the reviews reflect the generally held opinions of experts in the field. The Journal has broadened its scope and has become a forum for publishing primary research together with brief reports related to pain and pain interventions. Submissions from all over the world have been published and are welcome. Official journal of the British Pain Society.